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Body Fluids
I. water
a. the most important nutrient of life
acts as a solvent helps maintain normal body temperature facilitates digestion and promotes elimination Lubricant Insulator
Water overview
*Water comprises about 50% -70% of the total body weight *Varies with age weight gender
When a person loses more than 10% of his total body fluids,he can DIE!!!
II. extracellular fluid (ECF) compartment a. contains fluid outside the cells includes: i. intravascular fluid ii. interstitial fluid
Intravascular (IV)
Within vascular space
in the normal adult, total-body water: i. represents 50% - 70% of the body weight of a normal adult ii. total-body water is divided as follows: a. cell fluids b. ECF c. plasma d. interstitial fluid
CSF, Pleural fluid, Synovial Fluid and peritoneal fluid Secreted by epithelial cells Bound
1/3 of ECF Plasma Bone and 7.5% Cartilage 7.5% Higher protein Dense content Connective tissues 7.5%
Total body water = 0.6 X weight (kg) for children and adults and 0.78 X weight (kg) for neonates and infants
Electrolytes
I. substances capable of breaking down into electrically charged ions when dissolved in solution II. ion a. atom or molecule carrying an electrical charge b. types of ions i. cations ii. Anions
Major Electrolytes
Sodium Potassium Calcium Magnesium Chloride Bicarbonate Phosphate
Non-electrolytes
substances incapable of breaking down into electrically charged ions when dissolved in solution and, consequently, remain intact
Measurement of Electrolytes
measured in terms of their chemical combining power, or chemical activity unit of measurement of electrolytes i. the milliequivalent (mEq) - describes the chemical activity of electrolytes
Fluid Intake
Healthy adult ingests fluid as part of the dietary intake. 90% of intake is from the ingested food and water 10% of intake results from the products of cellular metabolism
Fluid Output The average fluid losses amounts to 2, 500 ml per day, counterbalancing the input.
The routes of fluid output are the following: SENSIBLE LOSS INSENSIBLE LOSS
Water Metabolism
Daily Balance: turnover ~ 2500 ml
a. Intake
i. drink ~ 1500 ml ii. food ~ 700 ml iii. metabolism ~ 300 ml
b. Losses
i. urine ~ 1500 ml ii. skin ~ 500 ml
insensible losses ~ 400 ml sweat ~ 100 ml
iii. lungs ~
Fluid Spacing
Fluid Imbalances
5. Maintain skin integrity 6. Provide frequent oral care 7. Teach patient to change position slowly to avoid sudden postural hypotension
Electrolyte Imbalances
HYPERNATREMIA
sodium excess in the ECF
HYPONATREMIA
Refers to a Sodium serum level of less than 135 mEq/L. This may result from excessive sodium loss or excessive water gain.
HYPOKALEMIA
potassium deficit in the ECF, or serum potassium level less than 3.5 mEq/L
NURSING MANAGEMENT
Continuously monitor the patient Prevent hypokalemia Correct hypokalemia by administering prescribed IV potassium replacement.
Administer IV potassium no faster than 20 mEq/hour and hook the patient on a cardiac monitor. A concentration greater than 60 mEq/L is not advisable for peripheral veins.
HYPERKALEMIA
potassium excess in the ECF, or serum potassium level greater than 5.0 mEq/L
calcium rich foods: losses: a. milk a. urine, feces, bile, digestive b. cheese secretions, c. calcium-fortified perspiration tofu normal range for d. almonds serum calcium???
HYPOCALCEMIA
calcium deficit in the ECF, or serum calcium level less than 8.5 mEq/L
HYPOCALCEMIA
signs/symptoms
mental changes convulsions spasm of larygneal muscles ECG changes Management Dependent on the presenting SSx Administration of medications such as Calcium Gluconate (IV) Calcium Chloride if severe Calcium carbonate
HYPERCALCEMIA
calcium excess in the ECF, or serum calcium level greater than 10.5 mEg/L
HYPERCALCEMIA
signs/symptoms
muscular weakness constipation anorexia, nausea, vomiting decreased memory and attention span polyuria and polydipsia renal stones neurotic behavior cardiac arrest
HYPERCALCEMIA
The need for treatment of hypercalcemia depends on the degree of hypercalcemia and the presence or absence of clinical symptoms.
Electrolytes Magnesium
second most important cation in the ICF a. primarily found in the ICF
Electrolytes Magnesium
losses: a. excreted by the kidneys normal range for serum magnesium: a. 1.3 - 2.1 mEg/L (mmol/L) with 1/3 of that bound to plasma proteins
HYPOMAGNESEMIA
magnesium deficit in the ECF, or serum magnesium level less than 1.3 mEg/L
HYPOMAGNESEMIA
signs/symptoms
neuromuscular irritability increased reflexes coarse tremors convulsions cardiac manifestations tachyarrythmias increases susceptibility for digitalis toxicity mental changes disorientation mood changes
HYPOMAGNESEMIA
Management
Treatment of hypomagnesemia depends on the degree of deficiency and the clinical effects.
HYPERMAGNESEMIA
magnesium excess in the ECF, or serum magnesium level greater than 3.0 mEg/L
HYPERMAGNESEMIA
signs/symptoms
flushing a sense of skin warmth hypotension depressed respirations drowsiness, hypoactive reflexes, and muscular weakness cardiac abnormalities
Management
Dialysis Cardiotoxicity Management Calcium Gluconate 10% 1-10 ml IV
HYPOPHOSPHATEMIA
phosphate deficit in the ECF, or serum phosphate level less than 2.5 mEg/L
signs/symptoms
cardiomyopathy acute respiratory failure seizures decreased tissue oxygenation joint stiffness
HYPOPHOSPHATEMIA
Standard intravenous preparations of potassium phosphate are available and are routinely used in malnourished patients and alcoholics. Oral supplementation also is useful where no intravenous treatment is available. Historically one of the first demonstrations of this was in concentration camp victims who died soon after being refed: it was observed that those given milk (high in phosphate) had a higher survival rate than those who did not get milk.
HYPERPHOSPHATEMIA
phosphate excess in the ECF, or serum phosphate level greater than 4.5 mEg/L
signs/symptoms
symptoms of tetany, tingling of the fingertips and around the mouth numbness muscle spasms
HYPERPHOSPHATEMIA
Management
High phosphate levels can be avoided with phosphate binders and dietary restriction of phosphate.
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